Monica V Blakley, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R872218 Issued in MS

Practice address

605 Stadium Dr
Hattiesburg, MS 39401-4156

Phone

(601) 450-0310

Fax

(601) 450-0321

NPI assigned

May 28, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Covington County Hospital

  • Rural Health Clinic/Center
  • Collins, MS
  • NPI 1598769044
  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  MS

  Medicare reassignment
• Conx Care Corporation

  • Family Medicine Physician
  • Hattiesburg, MS
  • NPI 1548183510
  NPD (past)
• Hattiesburg Public School and Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Hattiesburg, MS
  • NPI 1023087400
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1982923942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394030511",
            "telephone_number": "601-450-0310",
            "fax_number": "601-450-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 STADIUM DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014156",
            "telephone_number": "601-450-0310",
            "fax_number": "601-450-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKLEY",
        "first_name": "MONICA",
        "middle_name": "V",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-28",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R872218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "12131306",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04157249",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "9971504",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blen D Blackwell, PA-C
• Kory Blackwell
• George Joshua Blair, MD
• Hayden Elise Blakeman
• Susan E Blakeney, FNP
• Bertha J Blanchard, MD
• Kevin P Blanchard, MD
• Bluebonnet Dental Care Hattiesburg LLC
• Lynn Boardman, MS,CCC-SLP
• Ketankumar Bodarya, MD

• Family Nurse Practitioner in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.